AUDITORY TUBE AND

STERNOCLEIDOMASTOID
MUSCLE
BY: SRISHTI SRIVASTAVA
RUTUJA KANGULE
KANAKAA DULANI
AUDITORY TUBE
 AUDITORY TUBE

• OTHER NAMES : PHARYNGOTYMPANIC TUBE

EUSTACHIAN TUBE
A bony and cartilaginous tube connecting the middle ear with the nasopharynx and
equalizing air pressure on both sides of the tympanic membrane. It is  approximately at the
level of the inferior nasal concha.
It is approximately 35mm (1.4 in) long and 3 mm (0.12 in) in diameter .
 BONY PART OF AUDITORY TUBE

• The bony part (1/3) nearest to the middle ear and is about 12 mm in length.
• It begins in the anterior wall of the tympanic cavity and, gradually narrowing, ends at the
angle of junction of the squamous and the petrous parts of the temporal bone,
 CARTILAGINOUS PART
• The cartilaginous part of the Eustachian tube is about 24 mm in length and is formed of a
triangular plate of elastic fibrocartilage.
• . The cartilage lies in a groove between the petrous part of the temporal bone and the 
great wing of the sphenoid; this groove ends opposite the middle of the 
medial pterygoid plate.
• It is covered with ciliated pseudostratified columnar epithelia and is thin in the osseous
portion, while in the cartilaginous portion it contains many mucous glands and near the
pharyngeal orifice a considerable amount of adenoid tissue,
 MUSCLES
• There are four muscles associated with the function of the Eustachian tube:
• Levator veli palatini (innervated by the vagus nerve)
• Salpingopharyngeus (innervated by the vagus nerve)
• Tensor tympani (innervated by the mandibular nerve of trigeminal nerve)
• Tensor veli palatini (innervated by the mandibular nerve of trigeminal nerve)
• The tube is opened during swallowing by contraction of the tensor veli palatini and levator
veli palatini, muscles of the soft palate.
 FUNCTION

• It has mainly two functions

• 1. PRESSURE EQULIZATION
• 2. MUCUS DRAINAGE
 PRESSURE EQUALIZATION
• Under normal circumstances, the human Eustachian tube is closed, but it can open to let
a small amount of air through to prevent damage by equalizing pressure between the
middle ear and the atmosphere.
• Pressure differences cause temporary conductive hearing loss by decreased motion of
the tympanic membrane and ossicles of the ear.
•  Various methods of ear clearing such as yawning, swallowing, or chewing gum may be
used to intentionally open the tube and equalize pressures. When this happens, humans
hear a small popping sound, an event familiar to aircraft passengers, scuba divers, or
drivers in mountainous regions.
 
 MUCUS DRAINAGE

• The Eustachian tube also drains mucus from the middle ear.
• Upper respiratory tract infections or allergies can cause the Eustachian tube, or the
membranes surrounding its opening to become swollen, trapping fluid, which serves as a
growth medium for bacteria, causing ear infections. This swelling can be reduced through
the use of decongestants . Ear infections are more common in children because the tube
is horizontal and shorter, making bacterial entry easier, and it also has a smaller diameter,
making the movement of fluid more difficult. In addition, children's developing immune
systems and poor hygiene habits make them more prone to upper respiratory infections.
 CLINICAL SIGNIFICANCE

1. OTITIS MEDIA
2. BAROTITIS
3. PATULOUS EUSTACHIAN TUBE
4. RHINOSINUSITIS
5. MYRINGOTOMY
6. EUSTACHIAN TUBE PROSTHESIS
 OTITIS MEDIA
• Otitis media, or inflammation of the middle ear, commonly affects the Eustachian tube.
Children under 7 are more susceptible to this condition, one theory being that this is
because the Eustachian tube is shorter and at more of a horizontal angle than in the adult
ear. Others argue that susceptibility in this age group is related to immunological factors
and not Eustachian tube anatomy.
• Some people are born with a dysfunctional Eustachian tube that is much slimmer than
usual. The cause may be genetic, but it has also been posited as a condition in which the
patient did not fully recover from the effects of pressure on the middle ear during birth
(retained birth compression It is suggested that Eustachian tube dysfunction can result in
a large amount of mucus accumulating in the middle ear, often impairing hearing to a
degree. This condition is known as otitis media with effusion, and may result in the mucus
becoming very thick and glue-like, a condition known as glue ear.
 BAROTITIS

• Barotitis, a form of barotrauma, may occur when there is a substantial difference in air or
water pressure between the outer and the inner ear — for example, during a rapid ascent
while scuba diving, or during sudden decompression of an aircraft at high altitude.
 PATULOUS EUSTACHIAN TUBE
• A patulous Eustachian tube is a rare condition in which the Eustachian tube remains
intermittently open, causing an echoing sound of the person's own heartbeat, breathing,
and speech. This may be temporarily relieved by holding the head upside down
 RHINOSINUSITIS

• Recurring and chronic cases of sinus infection can result in Eustachian tube dysfunction
caused by excessive mucus production which, in turn, causes obstruction to the openings
of the Eustachian tubes.
• Sinusitis, also known as a sinus infection or rhinosinusitis, is inflammation of the 
mucous membrane that lines the sinusesresulting in symptoms.Common symptoms
include thick nasal mucus, a plugged nose, and facial pain.
 MYRINGOTOMY

• Surgical eardrum piercing

• In severe cases of childhood inner ear infections and Eustachian tube blockage, ventilation
can be provided by a surgical puncturing of the eardrum to permit air equalization, known
as myringotomy. The eardrum would normally naturally heal and close the hole, so a tiny
plastic rimmed grommet is inserted into the hole to hold it open. This is known as a 
tympanostomy tube. As a child grows, the tube is eventually naturally expelled by the body.
Longer-lasting vent grommets with larger flanges have been researched, but these can
lead to permanent perforation of the eardrum.
 EUSTACHIAN TUBE PROSTHESIS
• Another approach to permitting middle ear drainage is the use of a prosthesis
inserted into the Eustachian tube, to assist in holding the tube open. The
prosthesis does not necessarily hold the tube completely open all the time, but may
instead lightly brace the tissue walls of a narrow tube to assist in venting.
• One such example invented in 1978 is a silicone tube with a flange at the top,
which keeps it from dislodging and sliding out into the throat. However, in a study in
1978 it was not found to be effective for long-term use, and would eventually
become internally blocked with mucus or otitis media, or dislodged from its
position.
STERNOCLEIDOMASTOID
MUSCLE
• The Sternocleidomastoid muscle is one of the largest and most superficial cervical muscle
of the neck. 
• The primary actions are rotation of head to the opposite side of the neck. 
• The Sternocleidomastoid muscle is innervated by spinal root of accessory nerve.
• It has two heads:
1. Clavicular head
2. Sternal head
 ORIGIN

• Sternal head – it is tendinous which arises from the superolateral part of the anterior
surface of manubrium.
• Clavicular head – it is musculotendinous (comprising both muscular and tendinous tissue)
arising from the superior border of medial one-third of the clavicle.
 INSERTION

1. by a thick tendon into the lateral surface of mastoid process , from its tip to superior
border.
2. by a thin aponeurosis into the lateral half of the superior nuchal line
 of the occipital bone.
 NERVE SUPPLY

motor supply – spinal accessory nerve

 proprioceptive/sensory supply – branches from ventral rami of C2
 STRUCTURE
The one head of sternocleidomastoid muscle originates from manubrium of the sternum
and the other head originates from the superior border of the medial third of the clavicle.
 
• It travels obliquely across the side of the neck and inserts at the mastoid process of the
temporal bone of the skull.
 
• This muscle is thick and narrow at the centre , and broader and thinner at either end.
 
• It divides the anterior and posterior triangles of the neck
 ACTIONS

• When one muscle contracts:

1. It turns the chin to the opposite side.
2. It can also tilt the head towards the shoulder of the same side. 

• When both SCM muscles contract together: 

1. They draw the head forwards, as in eating and in lifting the head from pillow.
2. With longus colli, they flex the neck against resistance.
3. It stabilizes the head and elevates rib with the help of clavicular head of muscle during forced inspiration.
 ARTERIAL SUPPLY

• Arterial supply- one branch each from superior thyroid artery and suprascapular artery and, two
branches from the occipital artery supply the big muscle.
• Upper one third of SCM is supplied by branches of occipital artery
• The middle third of the SCM muscle received its blood supply from a branch of the superior
thyroid artery, the external carotid artery, or branches of both
• The lower third of the muscle was supplied by a branch arising from the suprascapular artery, the
transverse cervical artery, the thyrocervical trunk, or the superficial cervical artery. 
 RELATIONS
• Superficial
1) Skin
2) a)Superficial fascia
b)Superficial lamina of the deep cervical fascia
3)Platysma
4)External jugular vein, and superficial cervical lymph nodes lying along the vein
5) a)Great auricular
b)Transverse or anterior cutaneous
c)Medial supraclavicular nerves
6)The parotid gland overlaps the muscle
Deep
1) Bones and joints
a)Mastoid process above and,
b)Sternoclavicular joint below

2)Carotid sheath
3)Muscles
a)Sternohyoid
b)Sternothyroid
c)Omohyoid
d)Three scaleni
e)Levator scapulae
f)Splenius capitis
g)Longissimus capitis
h)Posterior belly of digastric
4) Arteries;
a)Common carotid
b)Internal carotid
c)External carotid
d)Sternocleidomastoid arteries
e)Occipital
f)Subclavian
g)Suprascapular
h)Transverse cervical
5) Veins
a)Internal jugular
b)Anterior jugular
c)Facial
d)Lingual
6) Nerves
a)Vagus
b)Ansa cervicalis
c)Cervical plexus
d)Upper part of brachial plexus
e)Phrenic
7) Lymph nodes, deep cervical
 CLINICAL SIGNIFICANCE
• Examination of the sternocleidomastoid muscle forms part of the examination of the
cranial nerves. It can be felt on each side of the neck when a person moves their head to
the opposite side. The triangle formed by the clavicle and the sternal and clavicular heads
of the sternocleidomastoid muscle is used as a landmark in identifying the correct location
for central venous catheterization.
• Contraction of the muscle gives rise to a condition called torticollis or wry neck, and this
can have a number of causes. Torticollis gives the appearance of a tilted head on the side
involved. Treatment involves physiotherapy exercises to stretch the involved muscle and
strengthen the muscle on the opposite side of the neck. Congenital torticollis can have an
unknown cause or result from birth trauma that gives rise to a mass or tumour that can be
palpated within the muscle.
• Although there are many varieties of torticollis depending on the causes, the common
types are;
• Rheumatic torticollis- due to exposure to cold or draught
• Reflex torticollis- due to inflamed or suppurating cervical lymph nodes which irritate the
spinal accessory nerve
• Congenital torticollis- due to birth injury
THANK YOU